Publications by authors named "Tevfik Özlü"

68 Publications

[Pneumococcal infections and protection with vaccination in adult chronic lung diseases].

Tuberk Toraks 2020 Sep;68(3):305-320

Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey.

Pneumococcal infections are an important cause of mortality and morbidity in Chronic Lung Diseases. However, exacerbations, which make the treatment of diseases very difficult, and corticosteroids used during treatment carry a great risk of pneumococcal infection and adversely affect the treatment. The most rational way to reduce the negative impact of pneumococcal infections on the clinical and economic burden of Chronic Lung Diseases is vaccination of the risky population. Although, vaccination recommendations are well defined, recommended by national and international guidelines and are paid by health authorities, in Turkey, vaccination rates in adults with chronic lung disease is far below the expected. Since physicians are considered to be the most important and reliable resource that can guide their patients in vaccination, applying pneumococcal vaccination routinely in all patients with chronic lung diagnosis and making it a part of daily practice will greatly contribute to reducing the clinical and economic burden of pneumococcal infections in these patients. In this review, the effects of pneumococcal diseases on chronic lung diseases, the risk and clinical burden of pneumococcal diseases in chronic lung diseases are discussed in the light of guidelines and current literature, and the importance of protection from pneumonia in these patients is emphasized. In addition to general information and efficacy data about pneumococcal vaccines available in our country, application methods and access routes to vaccines are also described.
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http://dx.doi.org/10.5578/tt.70012DOI Listing
September 2020

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)].

Tuberk Toraks 2020 Sep;68(3):205-217

Clinic of Chest Diseases, Hakkari State Hospital, Hakkari, Turkey.

Introduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up.

Materials And Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional.

Result: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively.

Conclusions: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.
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http://dx.doi.org/10.5578/tt.70135DOI Listing
September 2020

Can artificial intelligence distinguish between malignant and benign mediastinal lymph nodes using sonographic features on EBUS images?

Curr Med Res Opin 2020 Dec 24;36(12):2019-2024. Epub 2020 Oct 24.

Pulmonary Medicine, Karadeniz Technical University, Trabzon, Turkey.

Aims: This study aimed to develop a new intelligent diagnostic approach using an artificial neural network (ANN). Moreover, we investigated whether the learning-method-guided quantitative analysis approach adequately described mediastinal lymphadenopathies on endobronchial ultrasound (EBUS) images.

Methods: In total, 345 lymph nodes (LNs) from 345 EBUS images were used as source input datasets for the application group. The group consisted of 300 and 45 textural patterns as input and output variables, respectively. The input and output datasets were processed using MATLAB. All these datasets were utilized for the training and testing of the ANN.

Results: The best diagnostic accuracy was 82% of that obtained from the textural patterns of the LNs pattern (89% sensitivity, 72% specificity, and 78.2% area under the curve). The negative predictive values were 81% compared to the corresponding positive predictive values of 83%. Due to the application group's pattern-based evaluation, the LN pattern was statistically significant ( = .002).

Conclusions: The proposed intelligent approach could be useful in making diagnoses. Further development is required to improve the diagnostic accuracy of the visual interpretation.
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http://dx.doi.org/10.1080/03007995.2020.1837763DOI Listing
December 2020

Response to letter to the editor: Radiological approaches to COVID-19 pneumonia

Turk J Med Sci 2020 08 26;50(5):1442-1443. Epub 2020 Aug 26.

Department of Chest Diseases and Chest Surgery, University of Health Sciences, Atatürk Training and Research Hospital, Ankara, Turkey

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http://dx.doi.org/10.3906/sag-2005-230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491263PMC
August 2020

Radiological approaches to COVID-19 pneumonia

Turk J Med Sci 2020 04 21;50(SI-1):604-610. Epub 2020 Apr 21.

Atatürk Chest Diseases and Thoracic Surgery Centre, Health Sciences University, Ankara, Turkey

COVID-19 pneumonia has high mortality rates. The symptoms are undiagnostic, the results of viral nucleic acid detection method (PCR) can delay, so that chest computerized tomography is often key diagnostic test in patients with possible COVID-19 pneumonia. In this review, we discussed the main radiological findings of this infection.
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http://dx.doi.org/10.3906/sag-2004-160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195987PMC
April 2020

Demographic, Clinical and Management Characteristics of Newly Diagnosed COPD Patients in Turkey: A Real-Life Study.

Int J Chron Obstruct Pulmon Dis 2020 4;15:261-267. Epub 2020 Feb 4.

Department of Pulmonary and Allergic Diseases, Ankara Liv Hospital, Ankara, Turkey.

Purpose: In order to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naïve asthma and COPD patients in Turkey, a multicenter study in 2012 was initiated . We aimed to investigate the characteristics and therapies of COPD patients in the original study in more detail.

Patients And Methods: This nation-wide, multicentric, non-interventional, prospective, real-life observational cohort study was conducted in 122 centers. The newly diagnosed patients were not receiving any treatment before the recruitment. Their general characteristics, the combined GOLD 2011 COPD categories and exacerbation histories were noted. The patients were followed up with 3 voluntary visits for 1 year. Their adherence to the inhaled treatment according to GOLD 2011 was evaluated during follow-up visits.

Results: The study included 776 COPD patients. Their mean age was 59.4±9.1 years, and 11.9% of the patients were female. 35.1% of the patients were in the GOLD 2011 C and D category. 12.6% are frequent exacerbators, and 52.8% had at least one comorbid condition. 71.8% overtreatment rate was detected. Their attendance rates for three follow-up visits became 55.9%, 32.9% and 18.7%, respectively. The adherence rate to the treatment was measured as 81.9%.

Conclusion: Although these patients were diagnosed for the first time, the GOLD C and D categories and frequent exacerbator phenotype were found at a high rate. They were usually prescribed an overtreatment regimen. We think that newly diagnosed COPD patients should be evaluated carefully, and best effort should be made to treat these patients in accordance with the recommendations of the major COPD guidelines.
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http://dx.doi.org/10.2147/COPD.S211838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010334PMC
February 2021

[A rare disease; Erdheim-Chester disease presenting with spontaneous pneumothorax].

Tuberk Toraks 2019 Sep;67(3):225-230

Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis of unknown etiology, it is characterized by organ infiltration of foamy histiocytes. Diagnosis of ECD involves the analysis of histiocytes in tissue biopsies: these are typically CD68+ CD1a-. These characteristic histiocytes may be found in almost any tissue in cases of ECD. We present an interesting case of ECD that was presented by spontaneous pneumothorax and neurological involvement.
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http://dx.doi.org/10.5578/tt.68541DOI Listing
September 2019

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

Tuberk Toraks 2019 Sep;67(3):197-204

Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Introduction: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey.

Materials And Methods: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials.

Result: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency.

Conclusions: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.
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http://dx.doi.org/10.5578/tt.68707DOI Listing
September 2019

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)

Turk J Med Sci 2019 12 16;49(6):1662-1673. Epub 2019 Dec 16.

Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients.

Materials And Methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed.

Results: The following cut-off scores were used to indicate mortality risk: <2, low risk; 2–5, moderate risk; 5.1–8, high risk; >8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total IMPRES scores of greater than 8 (P < 0.001).

Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.
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http://dx.doi.org/10.3906/sag-1904-96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518657PMC
December 2019

Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism.

Adv Respir Med 2019 ;87(2):69-76

Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE.

Material And Methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%.

Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5-40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (± 0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591-0.858, p = 0.033).

Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism.
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http://dx.doi.org/10.5603/ARM.2019.0012DOI Listing
December 2019

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey.

Ann Thorac Med 2019 Jan-Mar;14(1):75-82

Chest Disease Clinic, Afyon State Hospital, Afyon, Turkey.

Objective: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey.

Methods: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey.

Results: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0%, 42.8%, 35.0%, and 13.2% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 ± 2.85 and 0.92 ± 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation.

Conclusions: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination.
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http://dx.doi.org/10.4103/atm.ATM_145_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341858PMC
February 2019

Sleep disturbances in patients with lung cancer in Turkey.

Tuberk Toraks 2018 Dec;66(4):297-303

Department of Chest Diseases, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey.

Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey.

Materials And Methods: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale.

Result: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia.

Conclusions: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.
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http://dx.doi.org/10.5578/tt.67689DOI Listing
December 2018

Prospective cross-sectional multicenter study on domiciliary noninvasive ventilation in stable hypercapnic COPD patients.

Int J Chron Obstruct Pulmon Dis 2018 10;13:2367-2374. Epub 2018 Aug 10.

Department of Pulmonology, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Background: Domiciliary noninvasive ventilation (NIV) use in stable hypercarbic COPD is becoming increasingly widespread. However, treatment compliance criteria and factors related to compliance remain to be defined.

Methods: This research was designed as a prospective, cross-sectional, multicenter real-life study. Chronic hypercapnic COPD patients who were using domiciliary NIV for at least 1 year and being followed up in 19 centers across Turkey were included in the study. The patients who used NIV regularly, night or daytime and ≥5 hours/d, were classified as "high-compliance group," and patients who used NIV irregularly and <5 hours/d as "low-compliance group."

Results: Two hundred and sixty-six patients with a mean age of 64.5±10.3 years were enrolled, of whom 75.2% were males. They were using domiciliary NIV for 2.8±2 years. Spontaneous time mode (<0.001) and night use (<0.001) were more frequent in the high-compliance group (n=163). Also, mean inspiratory positive airway pressure values of the high-compliance group were significantly higher than the low-compliance group (n=103; <0.001). Cardiac failure (=0.049) and obesity (=0.01) were significantly more frequent in the high-compliance group. There were no difference between 2 groups regarding hospitalization, emergency department and intensive care unit admissions within the last year, as well as modified Medical Research Council dyspnea and COPD Assessment Test scores. With regard to NIV-related side effects, only conjunctivitis was observed more frequently in the high-compliance group (=0.002).

Conclusion: Determination of the patients who have better compliance to domiciliary NIV in COPD may increase the success and effectiveness of treatment. This highly comprehensive study on this topic possesses importance as it suggests that patient and ventilator characteristics may be related to treatment compliance.
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http://dx.doi.org/10.2147/COPD.S164384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089109PMC
January 2019

Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey.

J Asthma 2019 05 6;56(5):553-561. Epub 2018 Jun 6.

k Department of Pulmonary Diseases, Faculty of Medicine , Ankara University , Ankara , Turkey.

Objective: This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients.

Methods: This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months.

Results: Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly.

Conclusions: Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.
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http://dx.doi.org/10.1080/02770903.2018.1471707DOI Listing
May 2019

[A rare case: Kikuchi-Fujimoto disease].

Tuberk Toraks 2017 Dec;65(4):337-341

Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Kikuchi-Fujimoto's disease (CFD) is a disease that usually exhibits self-limited benign lymph node involvement. Etiology of illness is not fully understood.Differential diagnosis should be performed well because lymph node involvement can be confused with lymphoma type diseases. A 35-year-old male patient with weakness, joint aches, fever, loss of appetite, weight loss, night sweating symptoms presented with the literature.
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http://dx.doi.org/10.5578/tt.40395DOI Listing
December 2017

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Turk Thorac J 2017 Jul 1;18(3):78-81. Epub 2017 Jul 1.

Department of Chest Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey.

Objectives: In the last 20 years, with the use of computed tomography (CT) angiography, the number of patients diagnosed with pulmonary thromboembolism (PTE) has increased. At the same time, data show that pulmonary embolism mortality has also reduced in this duration.

Material And Methods: In this study, we analyzed records of patients with PTE (using ICD's) in the hospital automation system from 2001 to 2013. Data regarding age, sex, date of diagnosis, diagnosis of cancer, hemodynamic status, initial and maintenance treatment, hospital length of stay, and hospital mortality were recorded. Primary endpoints of the study were hospital length of stay and all-cause hospital mortality.

Results: The total number of patients included in the study was 1185. The median age was 61 years in 2001 and 71 years in 2013. The number of patients who were diagnosed using CT increased from 10% to 92.8%. Between 2001 and 2013, the number of patients diagnosed with PTE increased, and of all patients with PTE, 13.7% was diagnosed in 2009. The hospital length of stay of 13 days declined to 9 days. The use of a vena cava filter in 2007 was 1.1% and that in 2013 was 4.6%. Mortality rate was 15%, however hospital mortality did not significantly differ over the years but varied between 9.4% and 18.8%. Increased use of thrombolytics in patients with massive PTE has been observed over the years. Massive PTE ratio in 2006 was 8.5% and thrombolytic use was 5.8%, however in 2013, these ratios were 2.6%, 6% respectively (p=0.017).

Conclusion: Finally, despite the increased number of patients diagnosed with PTE over the years, the mortality rate was not observed to have changed from 2001 to 2013.
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http://dx.doi.org/10.5152/TurkThoracJ.2017.16050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783086PMC
July 2017

Real life profile of asthma and chronic obstructive pulmonary disease patients in Turkey.

Tuberk Toraks 2017 Sep;65(3):169-179

Department of Chest Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey.

Introduction: Despite the presentation of similar symptoms, the airway diseases have different underlying pathophysiological processes and must be distinguished to enable the administration of appropriate treatment. In several studies the clinician- and patient-related causes of poor compliance to treatment in asthma/chronic obstructive pulmonary disease (COPD) patients have been evaluated. This study aimed to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naïve asthma and COPD patients in Turkey.

Materials And Methods: This national, multicentre, prospective, observational study was conducted in 122 centres. A questionnaire including items related to demographic, clinical, laboratory parameters was applied. All patients were intended to be followed-up for 12 months.

Result: 1892 adult patients (1116 asthma and 776 COPD) from 122 centres were enrolled. Overall 95%, 86% and 65% of intermittent, mild persistent and moderate persistent asthma patients were over-treated. Among COPD patients, the percentages of over-treated patients were 66%, 79% and 82% for those with GOLD stage A, B and C. Physicians' adherence to guidelines was appropriate in 93% of severe persistent asthma patients and 89% of GOLD stage D COPD patients. Among patients with high compliance to treatment, proportion of asthma patients with total control was 44% and that of COPD patients at GOLD stage A was 41%. In consecutive two visits, this figure increased to 52% and 63% in asthma patients and 54% and 50% in COPD patients.

Conclusions: The main findings are: (a) patients are frequently over-treated and (b) patients do not adhere to visits as expected, in both asthma and COPD.
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http://dx.doi.org/10.5578/tt.54065DOI Listing
September 2017

Prognostic Value of Uric Acid for Pulmonary Thromboembolism.

Respir Care 2017 Aug 20;62(8):1091-1096. Epub 2017 Jun 20.

Department of Pulmonary Medicine.

Background: Pulmonary thromboembolism is a serious cardiovascular condition with considerable morbidity and mortality. Clinical studies have indicated that hyperuricemia is an independent risk factor for cardiovascular events. The aim of this study was to investigate possible value of the serum levels of uric acid (UA) in predicting 30-d pulmonary thromboembolism-related mortality.

Methods: Pulmonary thromboembolism was confirmed by computed tomography pulmonary angiography, demographic data, troponin, systolic pressure and pulse on admission, and simplified pulmonary embolism severity index assessment. UA levels were analyzed on admission. The primary end point was all-cause mortality during the first 30 d.

Results: A total of 337 acute pulmonary thromboembolism subjects, of whom 59% were females, were enrolled. The median (interquartile range) serum UA level was 5.35 (4.1-7.3) mg/dL. Serum UA levels of deceased subjects were higher than those of alive subjects during the study period (6.9 [4.6-10.0] mg/dL vs 5.2 [4.1-7.0] mg/dL, = .038). In the receiver operating characteristic analysis, the area under the curve was 0.650 (CI 0.732-0.960) for UA levels for all-cause mortality. A level of serum UA ≥ 5 mg/dL showed 73% sensitivity and 88% negative predictive value for all-cause 30-d mortality. A weak correlation was determined between the UA levels and age (r = 0.25, < .001) and any troponin (r = 0.267, < .001). Serum UA level was an independent predictor of short-term mortality in pulmonary thromboembolism (odds ratio 1.2, = .002).

Conclusions: Serum UA levels may be a potential biomarker for predicting outcome in patients with acute pulmonary thromboembolism.
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http://dx.doi.org/10.4187/respcare.05433DOI Listing
August 2017

Classification of high-risk with cardiac troponin and shock index in normotensive patients with pulmonary embolism.

J Thromb Thrombolysis 2017 Feb;43(2):179-183

Department of Pulmonary Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Accurate risk stratification of normotensive patients with acute pulmonary embolism (PE) require further investigation. We aimed to develop a simple model using clinical (shock index) and laboratory findings (cardiac Troponin, echocardiography) to assess the risk of 30-day mortality in normotensive patients with acute PE. In this retrospective study, 489 normotensive patients with acute PE diagnosed objectively. The primary end-point was defined as a all cause 30-day mortality. Shock index was calculated on admission. The primary end-point occurred in 67 (13.7%, 95% CI 10.7-16.8) patients with acute PE. Predictors of complications included elevated cardiac troponin (OR 1.7, 95% CI 1.3-2.2) and shock index (OR 1.3, 95% CI 1.1-1.5) by multivariable analysis. Risk index point was created based on OR. The model identified stages (stage I: 0-1 point, stage II: 2 points and stage III: 3 point) with 30-day mortality rates of 4.3, 19 and 38.6 %, respectively. The shock index and cardiac troponin can be safely used in combination to determine intermediate risk in patients with PE in emergency departmant. The study provided observations that will require prospective validation before the proposed risk score is adopted in clinical practice.
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http://dx.doi.org/10.1007/s11239-016-1443-3DOI Listing
February 2017

Value of Cardiac Troponin and sPESI in Treatment of Pulmonary Thromboembolism at Outpatient Setting.

Lung 2015 Aug 4;193(4):559-65. Epub 2015 Apr 4.

Department of Pulmonary Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey,

Background: Currently, guidelines do not recommend any standard approach for treatment of pulmonary thromboembolism (PTE) at outpatient setting. We investigated the efficacy and safety of a 90-day anticoagulant treatment of outpatients diagnosed with PTE who had negative troponin levels and low-risk simplified pulmonary embolism severity index (sPESI) at presentation.

Methods: This prospective cohort study included a total of 206 patients with objectively confirmed acute symptomatic PTE. Any troponin negative (cTn-) and low sPESI patients (as classified Group-1) were treated in outpatient setting. The primary endpoint was all-cause mortality during the first 90 days, and the secondary endpoint included non-fatal symptomatic recurrent PTE or non-fatal major bleeding. Presence of cancer was excluded from sPESI score.

Results: Fifty-two of 206 patients were eligible for had Group-1, and 31 were treated at outpatients settings. The 90-day all-cause mortality rate was 3.2 % among patients who received outpatient treatment. Otherwise cTn+ and high-risk sPESI 90-day mortality rate was 43.7 %. No difference was found in terms of secondary endpoints between the patients who received outpatient treatment and those who received inpatient treatment in Group-1 (p = NS). In our study, cancer was present in 16 (51.6 %) of the 31 outpatients.

Conclusion: We observed that patients with acute PTE, low-risk sPESI, and negative troponin levels can be safely treated in the outpatient settings. Also the presence of cancer alone does not necessitate hospitalization.
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http://dx.doi.org/10.1007/s00408-015-9727-5DOI Listing
August 2015

Should Low-Molecular-Weight Heparin be Preferred Over Unfractionated Heparin After Thrombolysis for Severity Pulmonary Embolism?

Clin Appl Thromb Hemost 2016 May 27;22(4):395-9. Epub 2015 Jan 27.

Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Purpose: The role of low-molecular-weight heparin (LMWH) in managing nonmassive pulmonary embolism (PE) is well known. In unstable cases, especially after thrombolytic therapy for massive PE, unfractionated heparin (UFH) is preferred for PE management. This study aimed to investigate the effectiveness and safety of LMWH after thrombolytic therapy.

Methods: A prospective, observational multicenter trial was performed in 249 patients with acute PE who required thrombolysis. Massive and submassive PEs were categorized into 2 groups depending on whether they were treated with LMWH or UFH after thrombolytic treatment. The primary end point was all-cause mortality during the first 30 days; the secondary end point included all-cause mortality, nonfatal symptomatic recurrent PEs, or nonfatal major bleeding.

Results: The mean age at diagnosis was 60.7 ± 15.5 years. The PE severity was massive in 186 (74.7%) patients and submassive in 63 (25.3%). The incidence of all-cause 30-day death was 8.2% and 17.3% in patients with LMWH and UFH, respectively (P = .031). Major hemorrhage occurred in 4% (n = 5) and 7.9% (n = 10) of patients and minor hemorrhage occurred in 9% (n = 11) and 13.4% (n = 17) of the cases treated with LMWH and UFH, respectively.

Conclusion: These results suggest that LMWH treatment can be used safely in patients with PE after thrombolytic therapy.
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http://dx.doi.org/10.1177/1076029614564863DOI Listing
May 2016

A Rare Cause of Chylothorax: Hennekam Syndrome.

Turk Thorac J 2015 Jan 5;16(1):33-35. Epub 2014 Nov 5.

Department Chest Diseases, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.

Hennekam syndrome was defined as a syndrome characterized by a new autosomal recessive, severe lymphedema in legs, face and genitalia with intestinal lymphangiectasia, various face anomalies and severe mental retardation. A 21 years old male patient was examined due to bilateral pleural effusion. There were edema in both legs and eyelids, swelling in the scrotum and operation scar, broad forehead and face, depressed nasal bridge, epicanthal folds and micrognathia in the physical examination. Chylothorax was diagnosed due to level of pleural triglyceride (650 mg/dL). Lymphatic flow delayed in both lower extremities in lymphoscintigraphy. The patient was diagnosed as Hennekam syndrome due to face anomalies, lymphedema, epilepsy, chylothorax and mild mental retardation.
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http://dx.doi.org/10.5152/ttd.2014.3988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783044PMC
January 2015

Diagnostic value of suPAR in differentiating noncardiac pleural effusions from cardiac pleural effusions.

Clin Respir J 2016 Jan 4;10(1):61-6. Epub 2014 Aug 4.

Pulmonary Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.

Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is a newly discovered inflammatory biomarker. suPAR has not been previously studied in differentiating noncardiac pleural effusion (PF) from cardiac PF. The aim of our study was to assess the diagnostic value of suPAR in PF.

Methods: The concentration of PF-suPAR was measured by a commercialized enzyme-linked immunosorbent assay in a prospective cohort of 74 patients with PF, 18 patients with PF due to cardiac failure (CF) and 56 patients with noncardiac PF. The area under the curve quantified the overall diagnostic accuracy of the tests.

Results: The median pleural fluid suPAR level was found as 23 (5.4-102.8) ng/mL. The median PF-suPAR level in CF was significantly lower than that of noncardiac effusions [11.8 (5.4-28.9) ng/mL vs 26.7 (8.2-102.8) ng/mL, respectively, P < 0.001]. The area under the receiver operating characteristic curve was 0.878 (95% confidence interval: 0795-0.962, P < 0.001) for noncardiac pleural fluid suPAR. The sensitivity, specificity and positive predictive value of PF-suPAR for noncardiac effusions at the cutoff level of ≥17.6 n/mL was 88%, 83% and 94%, respectively. The suPAR level in PF was found to correlate with all of the biochemical parameters of PF.

Conclusions: suPAR is a potential new marker for the discrimination between cardiac and noncardiac PF.
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http://dx.doi.org/10.1111/crj.12186DOI Listing
January 2016

Frequency and predictors of obesity hypoventilation in hospitalized patients at a tertiary health care institution.

Ann Thorac Med 2014 Apr;9(2):87-91

Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Objectives: Patients with obesity hypoventilation syndrome (OHS) have significant morbidity and mortality. Early diagnosis and treatment is important and there are limited data on its prevalence and predictive factors. The objective of this observational study was to determine the frequency and predictors of OHS in hospitalized patients at a tertiary health care institution.

Materials And Methods: All blood gas analyses of hospitalized adult (age over 18 years) patients were prospectively recruited from the biochemistry laboratory at a tertiary health care center between August 2009 and July 2010. Patients who had hypercapnia (PaCO2 ≥ 45 mmHg) while breathing room air were included and clinical and laboratory data were obtained from hospital records. A standard questionnaire was also filled by face-to-face interview with patients and/or relatives.

Results: A total of 9480 patients' arterial blood gases were evaluated and 330 patients (3.4%) who met the selection criteria were included in the analysis during the study period. Hypoventilation was associated with acute diseases in 64.2% and chronic diseases in 35.8% of the patients. Of the chronic hypoventilation patients, 24.4% had OHS. Univariate logistic regression analysis showed that, female gender, body mass index (BMI), smoking, PaO2, SaO2 and a PaCO2/BMI <1.5 were significantly related to OHS. In multivariate logistic regression analysis, BMI >35 kg/m(2), SaO2 <91.4% and PaCO2 /BMI <1.5 were significantly related to OHS. A PaCO2/BMI <1.5 was an independent variable strongly predictive of OHS (odds ratio: 36.9, 95% of the confidence interval: 2.75-492.95, P = 0.007).

Conclusions: OHS is a common cause of chronic alveolar hypoventilation. A careful examination PaCO2 /BMI ratio may prevent misdiagnoses among hypercapnic patients.
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http://dx.doi.org/10.4103/1817-1737.128851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005167PMC
April 2014

Combination and comparison of two models in prognosis of pulmonary embolism: results from TUrkey Pulmonary Embolism Group (TUPEG) study.

Thromb Res 2014 Jun 19;133(6):1006-10. Epub 2014 Mar 19.

Ege University School of Medicine, Department of Pulmonary Medicine, İzmir, Turkey. Electronic address:

Background: Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model.

Methods: This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding.

Results: Of the 1078 study patients, 95 (8.8%) died within 30days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%.

Conclusions: The sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.
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http://dx.doi.org/10.1016/j.thromres.2014.02.032DOI Listing
June 2014

Red cell distribution width: a new predictor for chronic thromboembolic pulmonary hypertension after pulmonary embolism.

Chron Respir Dis 2014 May 4;11(2):73-81. Epub 2014 Mar 4.

1Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

The most important long-term complication of pulmonary thromboembolism is chronic thromboembolic pulmonary hypertension (CTEPH) that is associated with considerable morbidity and mortality. It is uncertain why some patients with acute pulmonary embolism (PE) develop CTEPH and others do not. Elevated red cell distribution width (RDW) has been associated with adverse outcomes of heart failure, PE, and idiopathic pulmonary hypertension. The aim of the present study was to investigate whether RDW might be a predictor of CTEPH in PE patients or not. This study is a retrospective cohort study. A total of 203 consecutive patients with acute PE were included. The RDW was higher in the CTEPH patients than the patients without CTEPH (17.04 ± 3.46, 14.64 ± 1.82, respectively, p = 0.015). RDW was also higher in the CTEPH patients at the time of diagnosis of CTEPH during follow-up compared with the baseline RDW level at the time of PE diagnosis (18.63 ± 3.58, 17.02 ± 3.59, respectively, p = 0.014). The optimal cutoff value of the RDW for predicting CTEPH was 14.65. The area under the curve of RDW for the prediction of CTEPH was 0.735 (95% confidence interval (CI): 0.600-0.869); in cases with RDW levels >14.65%, the specificity, sensitivity, and negative predictive value for CTEPH were 62% (95% CI: 0.55-0.69), 75% (95% CI: 0.47-0.92), and 96.7% (95% CI: 0.91-0.99), respectively. A multivariate regression analysis showed that RDW, hazard ratio: 1.58 (95% CI: 1.09-2.30), was a predictor of CTEPH (p = 0.016). High level of RDW was an independent predictor of CTEPH in PE patients. Therefore, RDW levels may provide a prediction for CTEPH in PE patients.
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http://dx.doi.org/10.1177/1479972314525057DOI Listing
May 2014

Prognostic value of red cell distribution width in patients with sarcoidosis.

Clin Respir J 2015 Jan 17;9(1):34-8. Epub 2014 Feb 17.

Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Background: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. There are no data on the indications for specific tests or optimal frequency for monitoring of the disease activity in sarcoidosis.

Methods: Complete blood counts, demographics and pulmonary function data from sarcoidosis patients evaluated between 2006 and 2012 were collated retrospectively. During follow-up, the latest red cell distribution width (RDW) values of the patients were recorded. The prognosis and diagnosis of sarcoidosis was based on according to the guideline. Sarcoidosis progression was classified as follows: remission, stable disease and progreesive disease.

Results: The diagnosis was based on histopathological findings in 93 out of 138 (67.4%) patients. In our cohort, the baseline mean RDW levels were 14.1% ± 1.2. The RDW distribution by stage was as follows: stage I: 14.0% (± 1.6), II: 14.2% (± 1.5), III: 13.8% (± 0.9) and IV: 15.8% (± 2.0). In patients with stage IV, baseline and follow-up values of RDW were found to be significantly higher than the other stages. While the mean baseline RDW was 14.8 (± 1.4) in the progressive disease, upon follow-up, the mean RDW had increased to 16.5% (± 1.4) (P = 0.021), No difference was found between the baseline and follow-up levels of RDW in the regressive and stable groups.

Conclusions: Serial RDW levels may be beneficial marker to predict progression of sarcoidosis.
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http://dx.doi.org/10.1111/crj.12101DOI Listing
January 2015

Predictive value of troponins and simplified pulmonary embolism severity index in patients with normotensive pulmonary embolism.

Multidiscip Respir Med 2013 May 28;8(1):34. Epub 2013 May 28.

Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Background: To investigate whether 2 cardiac troponins [conventional troponin-T(cTnT) and high sensitive troponin-T(hsTnT)] combined with simplified pulmonary embolism severity index (sPESI), or either test alone are useful for predicting 30-day mortality and 6 months adverse outcomes in patients with normotensive pulmonary embolism(PE).

Methods: The prospective study included 121 consecutive patients with normotensive PE confirmed by computerized tomographic(CT) pulmonary angiography. The primary end point of the study was the 30-day all-cause mortality. The secondary end point included the 180-day all-cause mortality, the nonfatal symptomatic recurrent PE, or the nonfatal major bleeding.

Results: Overall, 16 (13.2%) out of 121 patients died during the first month of follow up. The predefined hsTnT cutoff value of 0.014 ng/mL combined with a sPESI ≥1 'point(s) were the most significant predictor for 30-day mortality [OR: 27.6 (95% CI: 3.5-217) in the univariate analysis. Alone, sPESI ≥1 point(s) had the highest negative predictive value for both 30-day all-cause mortality and 6-months adverse outcomes,100% and 91% respectively.

Conclusions: The hsTnT assay combined with the sPESI may provide better predictive information than the cTnT assay for early death of PE patients. Low sPESI (0 points) may be used for identifying the outpatient treatment for PE patients and biomarker levels seem to be unnecessary for risk stratification in these patients.
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http://dx.doi.org/10.1186/2049-6958-8-34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668152PMC
May 2013

Carbonic anhydrase IX in the prediction of right ventricular dysfunction in patients with hemodynamically stable acute pulmonary embolism.

Clin Appl Thromb Hemost 2014 Nov 23;20(8):838-43. Epub 2013 Apr 23.

Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Right ventricular dysfunction (RVD) defined by echocardiography and/or by natriuretic peptides is a well-known predictor of prognosis in patients with pulmonary embolism (PE). This study investigated carbonic anhydrase IX (CA IX) levels for predicting echocardiographic RVD in patients with PE. A total of 150 normotensive patients with PE were included. The levels of CA IX, N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and high-sensitive cardiac troponin T were significantly elevated in patients with PE with RVD on echocardiography. A receiver-operating characteristic curve analysis showed a value of 0.751 for CA IX, 0.714 for NT-proBNP, and 0.650 for high-sensitive troponin-T to predict RVD on echocardiography. The cutoff value to predict RVD was 32.45 pg/mL for CA IX (sensitivity: 89.3% and specificity: 51.1%). There was a significant positive correlation between the CA IX level and the systolic pulmonary arterial pressure on echocardiography (ρ = .21; P = .035). The CA IX is a significant serologic predictor of RVD in acute PE and correlates with systolic pulmonary arterial pressure.
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http://dx.doi.org/10.1177/1076029613486540DOI Listing
November 2014

Prediction of right ventricular dysfunction from radiographic estimates of right descending pulmonary artery in hemodynamically stable pulmonary embolism patients.

Cardiol J 2013 ;20(2):184-9

Karadeniz Technical University, Faculty of Medicine, Department of Pulmonary Medicine, Trabzon, Turkey.

Background: The evaluation of right ventricular (RV) dysfunction by echocardiography is one of the most important established determinants of the prognosis of acute pulmonary embolism. The aim of the study was to investigate possible association between diameter of right descending pulmonary artery on chest X-rays and RV dysfunction by echocardiography in hemodynamically stable pulmonary embolism patients.

Methods: Eighty-nine patients with the diagnosis of hemodynamically stable pulmonary embolism were included.

Results: The frequency of RV dysfunction was significantly higher in patients with an enlarged right descending pulmonary artery on chest X-rays (p = 0.001). There was a significant positive correlation between the diameter of the right descending pulmonary artery on postero-anterior chest X-rays and the diameter of the RV (r = 0.469; p = 0.002). Diameter of right descending pulmonary artery on chest X-rays was also found as a significant predictor of RV dysfunction besides the troponin-T levels and systolic pulmonary arterial pressure (p < 0.05).

Conclusions: Diameter of right descending pulmonary artery on chest X-rays may provide information about the risk for pulmonary embolism patients and may be used as a prognostic radiological parameter for the appropriate management of acute pulmonary embolism.
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http://dx.doi.org/10.5603/CJ.2013.0032DOI Listing
August 2014